中国急性脑梗死伴心房颤动病人静脉溶栓有效性和安全性的Meta分析  

Efficacy and Safety of Intravenous Thrombolysis for Atrial Fibrillation in Patients with Acute Cerebral Infarction in China:a Meta-analysis

作　　者：程婷 周佩洋 任自敬 张瑞平 CHENG Ting;ZHOU Peiyang;REN Zijing;ZHANG Ruiping(Postgraduate Training Base,Jinzhou Medical University,Hubei University of Medicine,Jinzhou 121001,Liaoning,China)

机构地区：[1]锦州医科大学湖北医药学院研究生培养基地,辽宁锦州121001 [2]湖北医药学院附属襄阳市第一人民医院,湖北襄阳441000

出　　处：《中西医结合心脑血管病杂志》2021年第18期3094-3103,共10页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

摘　　要：目的系统评价中国急性脑梗死伴心房颤动病人接受静脉溶栓治疗后的有效性和安全性。方法计算机检索PubMed、EMbase、the Cochrane Library、中国生物医学文献数据库(CBM)、中国知网(CNKI)和万方数据库(WanFang Data),查找关于心房颤动对中国急性脑梗死病人静脉溶栓影响的队列研究,检索时限均为从建库至2020年5月,并追溯纳入研究的参考文献,采用RevMan 5.1软件进行Meta分析。结果33项研究涉及7524例病人纳入本Meta分析。结果显示:①在未经校正的分析中,与无心房颤动病人相比,心房颤动降低急性脑梗死病人溶栓后90 d良好预后率[OR=0.70,95%CI(0.54,0.92),P=0.009],但不影响早期神经功能改善[OR=0.86,95%CI(0.57,1.30),P=0.47]。②心房颤动增加溶栓后颅内出血转化风险[OR=3.33,95%CI(2.91,3.80),P<0.00001]、症状性颅内出血风险[OR=2.61,95%CI(1.95,3.48),P<0.00001]和溶栓后死亡风险[OR=2.04,95%CI(1.53,2.72),P<0.00001]。③在调整混杂因素后的分析中,心房颤动仍会增加溶栓后颅内出血转化风险[OR=2.63,95%CI(2.16,3.21),P<0.00001],但与90 d良好预后[OR=0.97,95%CI(0.93,1.02),P=0.23]和90 d内死亡率[OR=1.65,95%CI(0.92,2.98),P=0.09]无关。结论现有证据表明,在调整了潜在的混杂因素后,心房颤动虽会增加接受重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗的急性脑梗死病人的出血转化风险,但似乎与不良结局风险增高无关,有心房颤动病史和无心房颤动病史的病人似乎具有可比性的安全性和疗效结果。受限于纳入研究的质量和数量,上述结论尚需开展更多前瞻性、大样本、多中心、高质量的临床研究加以验证。Objective To evaluate the efficacy and safety of intravenous thrombolysis in patients with acute cerebral infarction and atrial fibrillation.Methods PubMed,EMbase,the Cochrane Library,CBM,CNKI,and WanFang Data were searched for the effect of intravenous thrombolysis on atrial fibrillation patients with acute cerebral infarction.The retrieval time was from the establishment of the database to May 2020.Meta-analysis was performed using RevMan 5.1 software.Results A total of 33 studies and 7524 patients were included in this Meta-analysis.In the uncorrected analysis,compared with patients without atrial fibrillation,better prognosis rate of acute cerebral infarction patients with atrial fibrillation decreased at 90 days after thrombolysis[OR=0.70,95%CI(0.54,0.92),P=0.009],but there was no significant difference in early neurological function improvement in patients without atrial fibrillation[OR=0.86,95%CI(0.57,1.30),P=0.47].Atrial fibrillation increased the risk of intracranial hemorrhage transformation after thrombolysis[OR=3.33,95%CI(2.91,3.80),P<0.001],symptomatic intracranial hemorrhage[OR=2.61,95%CI(1.95,3.48),P<0.001],and death after thrombolysis[OR=2.04,95%CI(1.53,2.72),P<0.0001].In the adjusted analysis,atrial fibrillation still increased the risk of intracranial hemorrhage transformation after thrombolysis[OR=2.63,95%CI(2.16,3.21),P<0.001],without better prognosis at 90 days[OR=0.97,95%CI(0.93,1.02),P=0.23]or mortality within 90 days[OR=1.65,95%CI(0.92,2.98),P=0.09].Conclusion The available evidence suggests that after adjusting for potential confound factors,atrial fibrillation increase the risk of hemorrhage transformation in patients with acute cerebral infarction who receive rt-PA intravenous thrombolysis,but does not associated with risk of adverse outcomes.The patients with or without a history of atrial fibrillation appear safety and efficacy.Limited the quality and quantity of included studies,more prospective,large sample size,multi-center,and high-quality clinical studies are needed to verify the

关 键 词：心房颤动 脑梗死 重组组织型纤溶酶原激活剂 静脉溶栓 系统评价 META分析 

分 类 号：R54[医药卫生—心血管疾病]